Dr Rachael Liebmann: Then

Back in 2017, I reflected on the increasing need to address shortages in the pathology workforce, because of the dwindling number of qualified professionals available to keep our services afloat.

I was concerned about the relentlessly increasing demands on pathology from the ageing population, more people being diagnosed with cancer and the increased demand for pathology investigations following on from increased access to genomic testing. I pointed out that the uncertainties and loss of continuity resulting from constant service reconfiguration did not help to retain mature professional colleagues in pathology.

At the time the pension issue was just beginning, but since then has become a major problem – not only for the ability to retain senior colleagues, but also for enabling pathologists to help out their service by carrying out extra sessions or acting as internal locums.

Back then we knew that workforce shortages were a major problem. We knew of the problems in our own departments and we had anecdotal evidence from other pathology services. However we had no definite figures on the number of vacancies and this was a huge stumbling block to making the case for the changes needed to tackle the problem. How can we argue for increased training numbers in pathology specialities, or for a relaxation in the rules on immigration for overseas pathologists, without concrete evidence of unfilled pathology posts?

For many years, the College had been asking members and Fellows to complete their workforce data on the website, which had some success, but limited uptake meant figures weren’t representative.

Improving our data

So we decided to undertake a census of each pathology specialty in turn. We considered an online survey to be the best way to obtain facts and figures.

The workforce team at the College, led by Assistant Registrars Avril Wayte and later Esther Youd, emailed every department in England, Scotland, Northern Ireland and Wales to find out this crucial information.

The first census looked at histopathology. We found that only 3% of departments had enough histopathologists to manage their existing caseload and 45% of departments had to send work away for reporting. In addition, half of all departments were using locums to meet demand.

The impact of our research

This data was turned into a workforce report, and launched on Radio 5 Live. Its impact was enormous. There were two mentions at main political party conferences and six specific parliamentary questions and government minister responses on the topic of the shortage of histopathologists. The shortage has been mentioned by 29 contributors to parliamentary debates and has been the topic of a Health and Social Care Committee debate building on work carried out by the College and Cancer Research UK.

Encouraging recruitment

Our members have been brilliant at volunteering to support schools careers talks, promoting pathology as a career and taking part in fun activities. The College's Communications department have made careers a major plank of their activity. Activities have been devised and the College is always ready to distribute freebies to volunteers to brighten up a display stand at a school or university careers fair or a science fair.

The team really focused on making careers materials on the College website accessible to all of our members. The Communications department produced new careers leaflets and information, wonderful videos explaining the work of a cellular pathologist, haematologist, medical microbiologist and chemical pathologist, as well as an off-the-shelf PowerPoint presentation and ‘how to’ videos, which can be used to create a really successful school careers talk. We have even created a pathology-themed pub quiz and an animation: What is a Pathologist?

Dr Esther Youd: Now

Despite the influence of our first workforce report and our associated outreach work, as well as our efforts to encourage recruitment, many of the concerns we had about workforce shortages in 2017 remain in 2019. We are making a positive impact though, and are continuing our efforts long into 2020 and beyond.

The continuing impact of our research

The impact of the histopathology workforce census continues to be seen, in discussions in parliament, increased influence by working with third sector organisations, input into national reviews such as Mike Richards’ review of cancer screening programmes and general awareness raising of what histopathologists do and how vital the workforce is to delivering patient care.

There have been several really tangible benefits from the research, including securing a pay premium worth more than £5,000 per year for trainees in England. The College is continuing to press for parity in the devolved nations and for trainees to whom this premium does not yet apply. The College submitted evidence to the Migration Advisory Committee and succeeded in getting all medical practitioners and biochemists included in the shortage occupation list, facilitating easier recruitment from overseas.

The best news this year came from recruitment – a 100% fill rate for histopathology training posts in England, reversing a downward trend we have witnessed over the last few years. This stands us in good stead when we press for increases in the number of training posts available, in order to provide the future histopathology workforce.

Other things the College is continuing to press for from this survey include suitable IT systems, digital pathology investment and increased training places for both doctors and biomedical scientists training in reporting for the IBMS/RCPath conjoint advanced specialist diploma.

What’s next? 

Our efforts to excite and engage trainees about the possibility of a career in pathology will continue into 2020.

Most importantly, good data remains a priority. It enables the College to argue from a position of strength to influence future workforce planning. We are currently doing this through engagement with the workforce stream of the NHS Long Term Plan in England and our Regional Council Chairs engage with their counterparts in Wales, Scotland and Northern Ireland.

As for future reports, data has been collected for biochemistry/chemical pathology and haematology/transfusion. Reports from these are to be published soon. We will continue the roll out of a census in each of our specialties, so if you receive an email or phone call, I hope we’ve convinced you that it really is worth contributing your data. The College will continue to fight on your behalf to raise the issue of workforce to ensure we can support the provision of the best pathology services for patients.